DESCRIPTION: The Women's Health Initiative for Nonsmoking (WINS) is a randomized clinical trial to test the short-and long-term efficacy and cost-effectiveness of a nurse-managed relapse prevention program for women smokers, in hospital for coronary artery disease (CAD). It explores factors that predict relapse over 6, 12, 24, and 30 months and components of the intervention that appear to be most effective in relapse prevention. Smoking is hazardous for CAD women; however, little is known about successful interventions for them. WINS tests an intervention designed for CAD women forced to abstain from smoking for 48-72 hours during hospitalization. A similar intervention, tested in men recovering from a heart attack at a health maintenance organization in the San Francisco Bay Area, had a biochemically confirmed cessation rate at one year of 71 percent for intervention and 45 percent for the control. In WINS, 350 women with CAD (angina pectoris, myocardial infarction, angioplasty, and coronary artery bypass surgery), admitted to six hospitals and who smoked in the month prior to hospitalization are randomized to experimental or control group. All subjects receive standardized physician advice on the hazards of smoking and the benefits of quitting. The experimental group subjects receive a 45-minute behavioral relapse prevention intervention at bedside augmented by self-help materials. Skills to avoid relapse in high-risk situations are provided. Over 12 weeks, the nurse telephones subjects five times at home to support nonsmoking and offer more coping skills. Subjects who relapse within 90 days are offered a second nurse counseling visit and one more telephone call. Pharmacologic therapy is reserved for subjects who exhibit extreme withdrawal symptoms in hospital or relapse after discharge; its use will be monitored in both groups. Outcomes are measured at 6, 12, 24, and 30 months are self-reported smoking status, confirmed by plasma cotinine measures. A set of covariates (demographics, smoking history, nicotine dependence, self-efficacy, alcohol use, co-morbidity, weight, exercise, depression, stress, well-being and function, psychological distress, social support, smoking cessation and adjunct therapy) will be studied to identify risk factors that predict relapse in CAD women.